Alexander McDowell

Preliminary Matters

Proceeding in Private

1.    The Registrant applied for the hearing to be held in private.  He submitted that he understood the need for transparency and that it was in the public interest for hearings not to be in private but submitted that the widespread news articles following the hearing in May 2025 has had an impact on his employment and on him gaining employment, in addition the unwanted attention has affected the safety and wellbeing of both himself and his partner who is a serving paramedic, together with colleagues in the paramedic profession.

2.    Ms Khorassani, on behalf of the HCPC, had no objection to the application for the hearing to be held partially in private.

3.    The Panel was referred to the HCPTS Practice Note on ‘Conducting Hearings in Private’, which states that as a general rule hearings are to be held in public in accordance with the ‘open justice’ principle. However, in certain circumstances it is in the interests of justice for the hearing to take place wholly or partially in private to protect the private life of the Registrant where matters relating to health and / or private life are to be referred to. 

4.    The Panel noted the submissions made by the parties and the principle of ‘open justice’.  The Panel considered the circumstances where it was in the interests of justice for a hearing to take place wholly or partially in private and agreed that any matters relating to the health and / or private life of the Registrant should be held in private, in order to protect the private life of the Registrant,  but the remainder of the hearing should be held in public.  

Background

5.    The Registrant was employed at South East Coast Ambulance Service NHS Trust (“the Trust”) from February 2016 to July 2022. The Registrant was first employed as an Emergency Care Support Worker. He then worked as an Associate Ambulance Practitioner and later as a Newly Qualified Paramedic once he qualified in July 2021. 

6.    The Registrant attended an emergency callout on 24 January 2022 to Service User A at her college (“the College”), where she was a residential student at the time. The callout related to Service User A allegedly attempting to take her own life. 

7.    It is alleged that the Registrant and Service User A began communicating on social media (Instagram) on or around 30 March 2022. It is alleged that the communications between the Registrant and Service User A continued and moved on to Snapchat, including times when the Registrant was at work and on a break. 

8.    Service User A alleges that there were many conversations with the Registrant where he said she was ‘teasing him’ and that he couldn’t wait to ‘fuck me’. Service User A also alleges that the Registrant complimented her on her body and would tell her the sexual things he couldn’t wait to do to her. Service User A alleges that there was one specific conversation when she told him she had started her period, and the Registrant allegedly told her, ‘last night was the one chance before Switzerland to fuck me and you blew it’. 

9.    Service User A alleges that during the conversations, the Registrant referred to what her college room looked like on the night he attended the emergency callout to her, including details such as her wearing pink crocs and a random bowl of Haribo’s being on the floor. 

10.    Service User A alleges that she was on the Registrant’s Instagram, and she clicked on his tagged photos to see that he had a girl called Person H on Instagram who tagged him in a picture of a kitten saying “new addition to the family”. Service User A alleges that she recognised the kitten as the Registrant had told her he lived alone with two cats. Service User A states that she then realised the Registrant had a girlfriend. Service User A alleges that when she sent the Registrant screenshots and asked him who Person H was, he got angry and blocked her. 

11.    Service User A alleges she had shown the messages to Person H who confirmed that the Registrant was her (Person H’s) boyfriend. 

12.    Service User A alleges that the last contact Service User A had with the Registrant was on 10 April 2022, when she asked him if he told all of his vulnerable patients how special they were and planned futures with them to cheat on his girlfriend. 

13.    On 22 April 2022, a message was inputted on the College’s safeguarding system in relation to Service User A by a residential staff member. The message relayed that Service User A had informed the staff member that the Registrant had made contact with Service User A over Instagram during the Easter holidays. 

14.    On 26 April 2022, Service User A spoke to the Student Wellbeing and Safeguarding Manager at the College (SB). Service User A spoke about her alleged contact with the Registrant. The College subsequently raised concerns about the Registrant to the Trust. 

15.    The Registrant was suspended on 26 April 2022 by the Trust pending the outcome of an internal disciplinary investigation into the concerns surrounding Service User A. 

16.    Service User A and SB met jointly with the Investigating Manager at the Trust (AB) to provide further information during a meeting on 17 May 2022. 

17.    On 22 June 2022, the Trust submitted a referral to the HCPC. It is alleged that the Registrant did not self-refer to the HCPC. 

18.    The Trust’s internal investigation concluded on 13 July 2022, and the Registrant was summarily dismissed on the grounds of gross misconduct. The Registrant appealed the Trust’s decision. The appeal hearing was chaired by AR, on 16 December 2022. The decision to dismiss the Registrant from the Trust was upheld, however the reasons for dismissal were amended.

19.    The Registrant attended the Substantive Hearing in April and May 2025 and was legally represented. The panel found that it was more probable than not that the Registrant had acted as alleged in relation to numerous Particulars. The panel also found that the Registrant’s fitness to practise was impaired on both the personal and public components by reason of his misconduct.

20.    The Substantive Hearing panel determined that the appropriate and proportionate sanction sufficient to meet to protect the public and the wider public interest was a Suspension Order for a period of 12 months.

21.    The Suspension Order came into effect on 27 June 2025 is due to expire on 27 June 2026.

Submissions

22.    Ms Khorassani, on behalf of the HCPC, confirmed the hearing today was a mandatory review of a Suspension Order under Article 30(1) of the Health Professions Order 2001.  She confirmed the Order expired on 27 June 2026 and the HCPC’s position is that the Registrant’s fitness to practise is still impaired and for the Order to be extended for a period of 6 months.

23.    The Panel was referred to the 19 page document provided by the Registrant on 30 May 2026, although Ms Khorassani submitted that prior to that date there had been no updates from the Registrant in response to the concerns raised by the panel when making the Suspension Order.

24.    Ms Khorassani confirmed that this was a Substantive Review Hearing and not an appeal and the Panel would initially need to consider if the Registrant’s fitness to practise was currently impaired and if so, then consider whether the existing order or another order needs to be in place to protect the public.

25.    The Panel was referred to the case of  Abrahaem v GMC [2008] EWHC 183 (Admin) which confirmed the Panel’s task at a review “is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed”. 

26.    Ms Khorassani confirmed there is a ‘persuasive burden’ on the Registrant to demonstrate at a review hearing that he has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”.

27.    The Panel were referred to the original finding of impairment and sanction at the Substantive Hearing and the advice provided by that panel to the Registrant as follows:

To assist a future reviewing panel, the Registrant may wish to consider: 

• Attending the review hearing. 

• Providing evidence of meaningful and comprehensive reflection upon his former misconduct and its impact on the service user; his colleagues; his profession; his regulator; and the reputational impact his actions have had upon all those parties.  

• Supplying up to date references relating to his professional and personal conduct. 

• Supplying details of recent relevant training and any personal development measures he has employed.

28.    Ms Khorassani acknowledged that the Registrant had engaged with the HCPC and attended the hearing today, she submitted on behalf of the HCPC that this was not enough for the Panel to consider that his fitness to practise was not currently impaired and to apply the appropriate sanction.

29.    Ms Khorassani confirmed that when reviewing any Article 30 sanction order, the key issue which needs to be addressed is what, if anything, has changed since the current order was imposed. She detailed the factors to be taken into account include:
•    the steps which the registrant has taken to address any specific failings or other issues identified in the previous decision;
•    the degree of insight shown and whether this has changed;

•    the steps which the registrant has taken to maintain or improve his professional knowledge and skills; and
•    whether any other fitness to practice issues have arisen.

30.    It was submitted that not all the concerns and issues raised by the initial panel had been sufficiently addressed and that a new concern had been received in relation to the Registrant and an investigation had commenced. When considering current impairment, it was submitted that the Panel would need to have regard to both the personal and public components.  

31.    The Panel were also referred to Dame Janet Smith’s comments within her Fifth Report for the Shipman Inquiry and the four-part legal test for determining impairment in fitness to practise hearings, which had been adopted into leading UK case law, in particular CHRE v Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin). The four limbs of this test require tribunals to determine whether the practitioner’s fitness to practise is impaired in the sense that the practitioner:

a) has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; 

b) has in the past brought and/or is liable in the future to bring the medical profession into disrepute; 

c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or 

d) has in the past acted dishonestly and/or is liable to act dishonestly in the future.

32.    The Panel were also referred to the Sanctions Policy which confirmed the sanctions must be considered in ascending severity, starting with considering if it was appropriate to take no action, issue a caution, replace the order with a conditions of practice order or extend the existing Suspension Order. 

33.    Ms Khorassani submitted on behalf of the HCPC that the Registrant’s fitness to practise remains impaired and invited the Panel to extend the Suspension Order for a minimum period of 6 months to allow the Registrant to continue to work with the HCPC.

34.    The Registrant confirmed that, although he took a different view to the decision made at the Substantive Hearing, he did not seek to go behind that decision.

35.    He explained his employment history over the last 4 years within the fire service initially then with a funeral service, detailing his roles, responsibilities and achievements.  He confirmed that his role at the fire service involved teaching clinical practises and he was very proud of his achievements within that role and that he now has a trusted position within a funeral service looking after vulnerable families during very difficult times when dealing with bereavement.

36.    He submitted that during this time he has reflected on the impact of his actions have had on the paramedic profession and his colleagues and he considered he shown insight and how to put that in practice.  He accepted he was not ready to return to a paramedic role immediately and had set out a plan within the documents he had submitted which would allow him to return to the service safely and with support.

37.    The Panel asked the Registrant to detail any training he had completed since the Suspension Order had been in place.  He confirmed that he had not really completed CPD hours but had listened to podcasts and had completed courses relating to dealing with vulnerable and grieving families, safeguarding vulnerable individuals and professions boundaries.  The Registrant was unable to provide specific dates or evidence of any training completed.  He explained that he wanted to complete his NQP portfolio after the last hearing, applying a “new set of eyes”, which did not simply include clinical skills but also dealt with professional skills and boundaries.  

38.    The Panel noted the material provided by the Registrant confirmed how his actions had impacted on his profession and on others, but asked the Registrant to explain how he felt his actions had impacted on the particular service user concerned and whether his actions had any impact on their health or life.  The Registrant explained he felt very sad about it, that it was hard to recall all the details now, but accepted the impact upon the service user was potentially far reaching.  He felt the service user potentially had different ideas where the relationship was going and a different perception about the nature of the relationship, but accepted the breakdown of the relationship had potentially far reaching impact on her mental health, which he regretted very deeply.  When asked by the Panel, the Registrant confirmed he had been unable to communicate this deep regret to the service user, but would be happy to do so if that was possible.

39.    The Panel asked the Registrant if he had any submissions to make to persuade them he would not act in a similar manner or repeat his actions in future.  The Registrant acknowledged there had been a breach of professional boundaries and explained how he felt now that the smaller decisions he made had become more important as they may lead to bigger consequences in future.  He was asked to give a practical example of this and confirmed that, he now had a different approach to his use of social media, confirming his use of it was now very different to how it had been at the time of these events and he now has a limited social media presence, partly due to his concern not to breach professional boundaries.

40.    The Panel asked the Registrant if he had any submissions to make in relation to his insight into dishonesty and the importance of honesty and integrity in all health care professions.  The Registrant confirmed his view that honesty and transparency was incredibly important in the profession and the need to be honest at all times.  He submitted that his transparency with his employers may provide some insight into this issue and that in his current role within the funeral service, being open and transparent is very important in order to gain the trust of the vulnerable families involved.

41.    Ms Khorassani, on behalf of the HCPC, then referred to a number of emails that were directly related to the Registrant’s responses to the Panel in relation to dishonesty and transparency with his employers.  These emails confirmed that the recent concern referred to the HCPC which related to an alleged failure to disclose to the fire service information about these proceedings and the Suspension Order imposed.  

42.    The Registrant was provided with time to consider these emails and submitted he had been transparent with the fire service from the outset in relation to the ongoing fitness to practise proceedings and this was confirmed within a statement he had provided within his bundle.

43.    The Panel confirmed it was not part of their review to consider the new concern referred to the HCPC but noted the submissions made by both parties. 

Legal Assessor’s Advice

44.    The Legal Assessor advised that this is a Review of a 12-month Suspension Order made following a Substantive Hearing in April and May 2025.  The Review is under Article 30(1) of the Health Professions Order 2001, and the Panel should consider the HCPTS Practice Notes on Review of Article 30 Sanction Orders and Fitness to Practise Impairment as well as the Sanctions Policy. 

1.    The Panel was reminded that Article 30(1) of the Health Professions Order 2001 provides panels with a power to:
-    extend the period for which the order has effect;

-    make an order which could have been made when the order being reviewed was made, or 

-    replace a suspension order with a conditions of practice order.

45.    The Panel was reminded that the review process is not a mechanism for appealing against or ‘going behind’ the original finding that the registrant’s fitness to practice is impaired. The purpose of the review is to consider:-
•    Whether the registrant’s fitness to practise remains impaired; and

•    If so, whether the existing order or another order needs to be in place to protect the public.

46.    The key issue which needs to be addressed is what, if anything, has changed since the current order was imposed. The factors to be taken into account include:
•    the steps which the registrant has taken to address any specific failings or other issues identified in the previous decision;
•    the degree of insight shown and whether this has changed;

•    the steps which the registrant has taken to maintain or improve his professional knowledge and skills; and
•    whether any other fitness to practice issues have arisen.

47.    The reviewing Panel’s task “is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed”. Abrahaem v GMC [2008] EWHC 183 (Admin). There is a ‘persuasive burden’ on the Registrant to demonstrate at a review hearing that he has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”.

48.    The decision reached must be proportionate, striking a fair balance between interfering with the registrant’s ability to practise and the overarching objective of public protection.

49.    The HCPC’s overarching objective is protection of the public and the purpose of fitness to practise proceedings is not to punish registrants for their past acts and omissions, but to protect the public from those who are not fit to practise. It does this by:
•    protecting, promoting and maintaining the health, safety and well-being of the public;
•    promoting and maintaining public confidence in the professions it regulates;
•    promoting and maintaining proper professional standards and conduct for members of those professions.

50.    In determining fitness to practise allegations, panels must take account of two broad components: the ‘personal’ component: the current competence and behaviour of the registrant concerned; and the ‘public’ component: those critically important public policy issues.

51.    In making proportionate decisions on sanction, panels need to strike a balance between the competing interests of the registrant and the HCPC’s overriding objective to protect the public. Therefore, decisions should deal with the concerns raised, but be fair, just and reasonable. Sanctions are not intended to be punitive. Panels should only take the minimum action necessary to ensure the public is protected. This means considering the least restrictive sanction available to them first, and only moving on to a more restrictive sanction if it is necessary to protect the public.

Decision on Impairment

52.    In reaching its decision the panel considered the submissions of the parties and all relevant information before it. It accepted the Legal Assessor’s advice and referred to the relevant HCPTS Practice Notes.

53.    The Panel first considered whether the Registrant’s fitness to practise remains impaired. The Panel was aware that the persuasive burden is upon the Registrant to demonstrate that his fitness to practise is no longer impaired. The Panel had regard to the decisions of the substantive panel however, it comprehensively reviewed the matter and exercised its own judgment in reaching its’ decision. 

54.    The Panel first considered whether the Registrant’s fitness to practise is currently impaired looking at both the personal component and the public component, taking account of the evidence from the Registrant.

55.    The Panel considered what had changed since the last hearing.  The Panel considered there was elements of some reflection since the last hearing but there was a limitation on what had been reflected on.  The Panel agreed there had been an avoidance on behalf of the Registrant and lack of acknowledgement of the impact on the service user, until prompted to address this by the Panel.  The Panel considered there was no evidence of any CPD completed since the previous hearing and limited information of any relevant training to address the issues and concerns raised by the previous panel.  The Panel agreed there was some evidence of remediation.

56.    The Panel accepted the Registrant was not currently working in the role of a paramedic so it may have been difficult to provide practical examples of actual reflection or to complete CPD hours.  The Panel also considered the Registrant had shown some element of remorse regarding his actions and had today confirmed he deeply regretted what had happened and that he appreciated the impact on the service user.  The Panel also noted the Registrant’s decision to limit his use of social media.

57.    However, the Panel agreed there was still a requirement for evidence to persuade them he had addressed the concerns and issues raised by the previous panel, that evidence would be required to prove the training required and there was still some hesitancy on his part to acknowledge the impact of his actions on the service user.  As such the Panel agreed there was a lack of depth to his insight and therefore a risk of repetition at this stage.

58.    The Panel considered to what extent the original panel’s concerns had been addressed, and it was noted that the persuasive burden was on the Registrant.  Whilst the Panel noted the Registrant had engaged with the process and attended the review hearing, the Panel considered that evidence of training and personal development had not been provided and the references provided were useful, although the Panel felt a reference or statement from someone at the fire service would have been useful.  Whilst the Panel noted the material provided by the Registrant, they still had concerns about his appreciation of the impact on the service user, the issue of dishonesty and integrity, and the errors in professional judgment which led to these behaviours.

59.    The Panel agreed there was insufficient proof of insight or remediation and, whilst limiting his use of social media was considered a good step, the Panel could not be satisfied the initial behaviour had been remediated or fully addressed within the material provided or submissions made by the Registrant.  The ongoing concern related to the breach of professional boundaries and, whilst accepting some progress had been made in other areas, there was insufficient evidence that all the issues raised by the previous panel had been fully addressed. As the concerns are behavioural, the Panel considered that to fully address them, the Registrant needed to show specific insight into how the behaviours occurred, how his reflective work has helped address them, and what he would do differently in future.

60.    The Panel considered the case of Abrahaem v GMC [2008] EWHC 183 (Admin) as referred to by Ms Khorassani and the Legal Assessor noting the task “is to consider whether all the concerns raised in the original finding of impairment...[have] been sufficiently addressed”. The Panel agreed the Registrant had not persuaded them that he has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”.

61.    The Panel determined that without the evidence set out above there continues to be a risk of relapse and repetition and consequent real risk of harm.

62.    The Panel therefore determined that the Registrant’s fitness to practice remained impaired on the personal component.

63.    The Panel went on to consider the public component. Due to the identified risk of relapse and repetition the Panel agreed there inevitably remains a risk to the public and there is a need to protect the public from risk of harm.

64.    In considering the public component the Panel found that members of the public would be concerned, and would not have confidence in the profession, or in the regulator, if the Registrant is permitted to return to unrestricted practice at present.

65.    The Panel was of the view that public confidence in the profession would be undermined if no finding of impairment were made due to the risk of repetition. Accordingly, the Panel found that the Registrant’s fitness to practise was impaired on the public component.

66.    The Panel concluded that the Registrant’s fitness to practise is currently impaired on both the personal and the public component and must go on to consider the issue of the appropriate sanction to address the concerns identified.

Decision on Sanction 

67.    The Panel looked at the Sanctions Policy considering the least restrictive sanction available to them first and only moving on to a more restrictive sanction if it is necessary to protect the public. The Panel was aware that the sanction is not a punishment for the Registrant but that it may have a punitive effect. The Panel was aware that once they reached a tentative view that an appropriate sanction has been identified, two further considerations should be made. One is to consider the next more severe sanction to the one identified in order to ensure that it sufficiently addresses the aims of a sanction. The other is to be satisfied that it is proportionate in the sense that it is no more severe than is required.
 
68.    The Panel first considered mediation, taking no action or a caution order and determined that these were not appropriate due to the serious nature of the concerns and the risk of relapse and repetition identified. None of these options would place any actual restriction on the Registrant’s practice, and therefore would not address the ongoing risks that the Panel has identified and would not adequately protect the public. In addition, these outcomes would not satisfy public confidence in the profession or the regulatory process.

69.    The Panel considered if any appropriate conditions of practice could be formulated to address the concerns and therefore protect the public and the public interest.  However, the Panel determined that no workable or enforceable conditions could be formulated to protect the public or the public interest.

70.    The panel therefore went onto consider the HCPC’s application to extend the current Suspension Order for a minimum of 6 months. It referred to the HCPC’s Sanction Policy which states: 

A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:

• the concerns represent a serious breach of the Standards of conduct,
performance and ethics;

• the registrant has insight;

• the issues are unlikely to be repeated; and

• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.

71.    The Panel agreed the current Suspension Order remained necessary for the reasons set out above, in that the Registrant has failed to show sufficient insight, had failed to evidence that he had adequately addressed all the concerns raised by the previous panel and that there is a likelihood of his relapsing with consequent risk of harm. The Panel therefore determined that the Suspension Order would be sufficient and necessary to protect the public or the public interest and that a Striking Off Order was not proportionate.

72.    The Panel agreed that an extension of the Suspension Order was necessary in order to protect the public and the wider public interest.  However, the Panel considered that, in light of the progress being made by the Registrant, a extension to the Order of only 3 months was required to allow the Registrant extra time to complete the required training and provide relevant practical examples for the next panel to consider.

73.    The Panel took into account the effect an extension to the Suspension Order would have on the Registrant, but concluded that public protection and the wider public interests outweighed the Registrant’s interests.

74.    A future reviewing panel would be aided by 

•    a reflective piece focussing on the initial errors in professional judgment, how these have been addressed, and what you would do differently in future. 
•    evidence of any CPD completed after the substantive hearing 
•    up to date references including a professional reference from a current employer. 

The Registrar is directed to suspend the registration of Alexander McDowell
for a further period of 3 months on the expiry of the existing order. 

This Order will be reviewed again before its expiry on 27 September 2026.

Right of Appeal

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

History of Hearings for Alexander McDowell